HC & Insurance Operations Senior Representative
2 weeks ago
Review and process insurance claims. Validate Member, Provider and other Claims information. Determine accurate payment criteria for clearing pending claims based on defined Policy and Procedure. Coordination of Claim Benefits based on the Policy & Procedure.
Maintain productivity goals, quality standards and aging timeframes. Scrutinizing Medical Claim Documents and settlements. Organizing and completing tasks per assigned priorities. Developing and maintaining a solid working knowledge of the healthcare insurance industry and of all products, services and processes performed by the team Resolving complex situations following pre-established guidelines
Requirements for this role include:
University degree or equivalent that required formal studies of the English language and basic Math 0-1 Year of experience where you had to apply business rules to varying fact situations and make appropriate decisions 0-1 Year of data entry experience that required a focus on quality including attention to detail, accuracy, and accountability for your work product.
0-1 Year of experience using a computer with Windows PC applications that required you to use a keyboard, navigate screens, and learn new software tools. 0-1 Year of experience that required prioritizing your workload to meet deadlines
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